Pain Speaks – Are we listening? Rethinking chronic persistent pain

Pain is something we all understand on a personal level—but try to describe it to someone else, and it suddenly becomes complex. It’s not just a physical sensation; it’s an experience that we feel in both body and mind. It is a personal experience and it is real.

Pain is typically classified as acute (short-term) or chronic/persistent (lasting longer than three months). Persistent pain, which can be life-changing, affects about 1 in 5 adults in the U.S. and Canada. It’s even more common among older adults with 1 in 3 people over 65 living with persistent pain and women experiencing it slightly more often than men (~17% of men vs. ~21% of women experience persistent pain on most days) (1).

The International Association for the Study of Pain (IASP) defines pain as an “unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” (2).

That phrase “sensory and emotional” matters. Pain isn’t just about tissue damage: what shows up on an X-ray or MRI; it’s shaped by what we feel, think, and experience. Two people can have the same injury yet describe their pain completely different.  Think about an athlete describing pain as they run up a hill feeling a heaviness and ache in their muscles versus someone being bitten by an animal. Attempts to make pain “objective” through rating scales often fail to capture the emotional, sensory, and physical complexity of what a person is really feeling (3).

In 1995, Dr. James Campbell called on healthcare providers to treat pain as the “fifth vital sign”, underscoring the need for better pain management. Yet, despite greater awareness, pain treatment outcomes haven’t necessarily improved (1).

Acute vs. Chronic/Persistent Pain

Acute pain is short-term, like when you stub your toe or sprain your ankle. It’s your body’s alarm system, a signal that something needs attention. As tissues heal, the pain fades and the “alarm” shuts off (3).

Persistent pain is different. It lingers long after tissues have healed, like an alarm that keeps ringing even when the fire is out. Over time, the nervous system can become hypersensitive, amplifying signals so that even gentle touch or simple movement feels painful (3).

This doesn’t mean the pain is “all in your head.” It’s real. But the way your brain and nervous system are processing signals has changed. To truly understand someone’s pain, we need to consider their culture, life experiences, psychological state, and context that the pain occurred in (1,3).

If you have heard the phrase, "issues are in your tissues", that work is validated with research by Sueki et al. who found that people who had previous painful experiences had a lower pain threshold and even a reduction in strength when recalling that pain (4–5). This shows that pain doesn’t just affect sensation, it also influences future physical responses. Pain affects the whole person, not just the site of discomfort.

The Bigger Impact of Pain

Persistent pain doesn’t only affect the body, it reaches into nearly every part of life. It influences mood, work, relationships, and even spiritual well-being. It can cause fatigue, sleep problems, and social isolation, and is strongly linked to anxiety and depression.

The ripple effect extends outward: families, workplaces, and society all bear the cost. The economic burden from healthcare use and lost productivity is significant.

From a biological standpoint, chronic stress plays a major role. Stress activates inflammation in the brain, which disrupts pain processing and lowers the pain threshold. These inflammatory changes can even alter the brain’s physical structure (neuroplasticity) (6).

This helps explain why mindfulness-based practices—which calm the stress response—can reduce pain. By lowering inflammation in the brain, mindfulness helps reset how pain is processed (6-7).  Much like inflammation can change the physical structure of the brain, mindfulness-based practices can also alter the brain's ability to change and reorganize by reforming new neural connections (7).

How Pain Is Treated

In Western medicine, treatment often focuses on reducing pain through medication, therapy, or surgery. These tools are important, but they rarely address the full picture. Pain is biopsychosocial—a blend of physical, emotional, and social factors—so no single approach works for everyone (1,3).

Persistent pain can also create a feedback loop: pain causes stress, and that stress makes pain worse. Breaking that cycle often requires more than medication alone.

Yoga and Pain

This is where yoga can play a supportive role. The word yoga means “to yoke” or “to unite,” which fits beautifully with the IASP’s definition of pain that includes both sensory and emotional components.

Yoga connects body, breath, and mind through movement (asana), breathwork (pranayama), and meditation (dhyana). The goal is integration, helping you feel safe and whole again in your own body.

Gentle yoga postures can rebuild trust in movement, while breathing and meditation help calm the nervous system. Together, they can quiet the persistent pain “alarm” and help retrain how the brain responds to pain signals.

Yoga, by way of mindfulness-based work can induce significant positive neurobiological changes in the brain.  Mindfulness based stress reduction (MBSR) can induce structural changes at the neural level which leads to observable improvements in mental health and well-being including improved emotional regulation and stress resilience, reduced levels of anxiety and depression and has demonstrates reduction in pain when compared to a placebo (7).  Therefore, practicing yoga through movement can be enhanced with a focus on awareness by paying attention to what is happening inside (thoughts, feelings, physical sensations) and outside (sights, sounds, smells), focusing on the present moment and having non-judgmental acceptance.

Research shows that yoga offers moderate benefits for persistent pain—especially low back and neck pain (8-9). In some studies, yoga performs as well as exercise (10), and sometimes even better than aerobic or educational interventions (11).

Most of the research conducted focuses on Hatha and Iyengar yoga:

• Hatha yoga emphasizes strength, flexibility, and mindfulness through slower-paced, breath-centered poses.

• Iyengar yoga focuses on precise alignment and often uses props to make postures accessible.

The type of yoga is important to consider as if the yoga you practice is different; the same benefits may not be experienced.

Importantly, yoga participants in some studies reported reduced use of pain medication even six months after the program (11). Researchers believe yoga helps by reducing neuroinflammation and encouraging positive neuroplastic changes (6).

Because yoga is often practiced in a group setting, it also helps reduce social isolation and builds supportive community networks—another key factor in pain resilience.

That said, yoga isn’t a “one-size-fits-all” treatment. Most yoga research has been conducted on middle-aged Caucasian women, so it’s unclear whether the same results apply to other populations (11).

Final Thoughts

Pain is deeply personal—more than a number on a pain scale or a finding on a scan. It’s an experience that touches the entire person.

Yoga may not erase persistent pain, but it can change your relationship to it. It may help with pain acceptance, ease fear of movement, and support a more compassionate connection to your body.

Ultimately, yoga’s greatest strength lies in what its name suggests: union. It’s not just movement—it’s a way of weaving together mind, body, and spirit.

If you live with persistent pain, consider exploring yoga—not as a cure, but as a gentle companion on your journey toward relief and reconnection.

References:

1)      Scher C, Meador L, Van Cleave JH, Reid MC. Moving Beyond Pain as the Fifth Vital Sign and Patient Satisfaction Scores to Improve Pain Care in the 21st Century. Pain Manag Nurs. 2018;19(2):125-129. doi:10.1016/j.pmn.2017.10.010

2)     IASP Announces Revised Definition of Pain.  International Association for the Study of Pain.  July 16, 2020. Accessed July 28, 2025.  https://www.iasp-pain.org/publications/iasp-news/iasp-announces-revised-definition-of-pain/

3)      Purvez A.  The Brain behind pain:  Exploring the Mind-Body Connection.  Rowman & Littlefield; 2022.

4)     Sueki DG, Dunleavy K, Puentedura EJ, Heard L, Van Der Heide P, Cheung M-S.  The differing effects of nociception and pain memory on pain thresholds in participants with and without a history of injury:  A pretest-posttest quasi experimental study.  J Behav Brain Sci. 2022;12:359-379.

5)       Sueki DG, Dunleavy K, Puentedura EJ, Heard L, Van der Heide P, Cheng MS. Differing Effects of Nociception and Pain Memory on Isometric Muscle Strength in Participants With and Without a History of Injury: A Quasi-Experimental Study. Am J Phys Med Rehabil. 2023 Sep 1;102(9):787-794. doi: 10.1097/PHM.0000000000002205. Epub 2023 Feb 3. PMID: 36753453.

6)     Fülöp B, Borbély É, Helyes Z.  How does chronic psychosocial distress induce pain?  Focus on neuroinflammation and neuroplasticity changes.  Brain, Behav, Immun 44:2025.  https://doi.org/10.1016/j.bbih.2025.100964 

7)      Calderone A, Latella D, Impellizzeri F, de Pasquale P, Famà F, Quartarone A, Calabrò RS. Neurobiological Changes Induced by Mindfulness and Meditation: A Systematic Review. Biomedicines. 2024 Nov 15;12(11):2613. doi: 10.3390/biomedicines12112613. PMID: 39595177; PMCID: PMC11591838.

8)     Crevelário de Melo R, Victoria Ribeiro AÂ, Luquine Jr CD, et al. Effectiveness and safety of yoga to treat chronic and acute pain: a rapid review of systematic reviews. BMJ Open 2021;11:e048536. doi:10.1136/ bmjopen-2020-048536

9)     Anheyer, D, Haller, H, Lauche R, Dobos G Cramer H. Yoga for treating low back pain: a systematic review and meta-analysis. Pain 163(4):p e504-e517, April 2022. | DOI: 10.1097/j.pain.0000000000002416

10)  Skelly AC, Chou R, Dettori JR, Turner JA, Friedly JL, Rundell SD, Fu R, Brodt ED, Wasson N, Winter C, Ferguson AJR. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Jun. Report No.: 18-EHC013-EF. PMID: 30179389.

11)   Wren AA, Wright MA, Carson JW, Keefe FJ. Yoga for persistent pain:  New findings and directions for an ancient practice.  Pain 152(3):477-480, March 2011.

Disclaimer: This blog is for informational purposes only and is not a substitute for medical advice. If you have concerns about your mental health, please consult your doctor or a qualified healthcare provider.